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Respiratory Assessment - Coggle Diagram
Respiratory Assessment
The inital assessment
ABCDE as you approach
Vital signs
Track and trigger - NEWS2
BTS guidelines on spO2.
The inital assessment
The relevant history - subjective
Presenting complaint - OLDCART
Any history of lung diseases e.g asthma, COPD
Any shortness of breath - what is normal for them
Has the patient previously had or do they currently have wheeze, cough chest pain, or haemoptysis?
Smoking history - passive or own
Family history
Exposure to things like dust, asbestos and mold.
The physical Assessment
The relevant history - subjective
Presenting complaint - OLDCART
Any history of lung diseases e.g asthma, COPD
Any shortness of breath - what is normal for them
Has the patient previously had or do they currently have wheeze, cough chest pain, or haemoptysis?
Smoking history - passive or own
Family history
Exposure to things like dust, asbestos and mold.
Inspection - Assess respiration
Rate, rhythm, depth - remember in exam
Chest movement - depth and symmetry
Effort - use of accessory muscles, nasal fairing, pursed lips
Oxygen saturation - normal around 95 to 98%
Multiple things can affect breathing - respiratory, cardiac, endocrine, neurological, pain, anxiety.
Inspection of the chest - anterior
Shape - any abornamties - barrel chest - pectus excavatum - pectus carinatum
Costal angle - normal <90 degrees, abnormal >90 degrees.
Inspection of the chest - posterior
Back and spine for any deformity that may affect breathing.
Scars/lesions/bruising
The ratio of transverse diameter to anterior-posterior diameter.
General Inspection
Hands and arms - peripheral cyanosis, clubbing fingers, tremors
Mouth and tongue - mucosa cyanosis, hydration - cracked lips and tongue.
Eyes - conjunctiva pallor - possible anemia.
Palpation -
Capillary refill - press fingers for 5 seconds and should refill in under 2 seconds.
Pulse - rate, rhythm, depth.
Chest palpations
Palpate firmly down the chest noting any:
Tenderness
Skin temperature
Moisture (Sweaty / Clammy)
Lumps or lesions
Surgical emphysema – air-trapped subcutaneous tissues under the skin
Can cause difficulty breathing due to swelling
Feels crackly under the skin as the air moves when touched
The symmetry of chest expansion - place your hand on the patient's shoulder and ask them to take a big breath, your hands should move symmetrically.
nsymmetrical could indicate -
Trauma -Fractured ribs
Neurological problems
Muscular dysfunction
Pneumonia
Pleural effusions
Pneumo/haemo thorax
Asculation - postterior chest
Ask the patient to put their arms across their chest
The patient to breathe normally through their mouth
Do not ask the patient to breath deeply – risk of hyperventilation
Tell the patient to indicate to you if they feel dizzy
Using the diaphragm, place the stethoscope flat on the chest.
Start at the apices and work down to the bases comparing side to side (in a J shape) round to mid-axillary line.
Listen to at least 1 complete breath cycle before moving the stethoscope
Auscultation - anterior chest
listen to 1 complete breath cycle with the patient breathing through the mouth.
Work down the midclavicular line from the apices
Use the bell to listen above the clavicle
Use the diaphragm for the rest of the chest down to the 6th rib space
In females, you will stop at the breast tissue
Listen round to the mid axillary line, particularly on the right to ensure the right middle lobe is examined.
Finding the same as posterior chest
The findings from auscultations - Normal like a soft low sound like wind in the trees.
Comman abnormal sounds
Wheeze, cracked, infection, COPD, emphysema, pleurisy, partially obstructed airway, pulmonary oedema.